Subscribe To

Saturday, February 28, 2015

First off,
let me be clear. I am not angry at doctors, in general. Neither am I an
apologist for them, although examples of both have occurred in my 291 previous
posts. Let’s face it: clinicians who treat Type 2 diabetes are in a tough spot.
They are like passengers on the Titanic, cruising along in the dark, comforted
by the knowledge that what they were taught in medical school is still the
current treatment protocol. They are also aware, however, that how
they are required to treat “will trap patients in a lifelong regimen of drug
management, obesity and escalating diabetes.”

The
Nutrition Debate #12: "Turning the Titanic", written 4
years ago, was a flop (only 30 page views). I guess people aren’t interested in
abstract metaphors and allusion. They want concrete solutions. Well, folks, please
don’t wait for the medical establishment to substantially change the standard
of care for Type 2 diabetes. There are too many forces in play now. I don’t
need to go into them all in detail. (It would just be a rant!) Suffice it to
say the entire field of “healthy eating” today is dominated by the powerful
food processors and manufacturers (“Agribusiness”) and drug manufacturers (“Big
Pharma”). They in turn influence public health policy and corrupt drug
research. To close the loop, their ads enrich the media and "miseducate" the public.

There are,
of course, notable exceptions. In the modern era, Robert Atkins, MD, raised
awareness of the benefits of low carbohydrate nutrition. He was attacked by the
medical establishment as “a dangerous fraud” (The
Nutrition Debate #4). Then, in 2008 Gary
Taubes, the 3-times Science in Society award winning journalist,
wrote, “Good Calories – Bad Calories” (“The Diet Delusion” in Britain). That
book had a huge impact, especially (although less than he’d hoped) on medical
practitioners. One MD, Kurt Harris, publicly acknowledged the influence that
GC-BC had on him.

Dr. Harris
was the creator of the “Archevore” protocol and “PaNu,” but he has since taken
down his websites. Interested readers, however, can find some of Harris’s
writing at Psychology Today here and The
Nutrition Debate #19. Another book I’d recommend is Volek and Phinney’s “The
Art and Science of Low Carbohydrate Living.” A very good online site
where I “went to school” is Dr. Bernstein’s Diabetes Forum. It’s full of
friendly and very helpful people.

Attempts by doctors and others to
escape from the current treatment protocol and reach a wider audience via
individual practice are by definition very limited. Blogs and other media do
reach more people but are not very remunerative. Some have done that anyway
with considerable success. The “Diet
Doctor,” Andreas Eenfeldt, MD, is one such. “Authority Nutrition,” created
by Kris Gunnars, a medical student, is another. And of course long-time blogger
Jimmy Moore has a very
popular website and many podcasts under his belt. Recently, he’s added a couple
of books with Eric Westman, MD, from Duke University.

There are
many other emerging "practitioners" who have seen the light, of course, most of
whom have now written books, some reviewed here. A recent favorite book, and an
easier read than GC-BC, is Nina Teicholz’s “The Big Fat Surprise.” She’s
obviously riffing off Taubes’s earth-shaking New York Times July 7, 2002,
Magazine cover story, “What
If It's All Been a Big Fat Lie.” My internist read Taubes’s piece
and suggested I try Atkins
Induction. That’s how it all
started for me.

Then, last
summer, the American Diabetes Association (ADA) officially issued a Position
Statement. Their “New
Nutritional Guidelines,” state clearly, “It is the position of the American
Diabetes Association (ADA) that there is not a “one-size-fits-all” eating
pattern for individuals with diabetes.” It
concluded, ““This Position Statement was written at the request of the ADA
Executive Committee, which has approved the final document.” My response was, “Cowabunga,
the ADA makes the turn” (#155). This “patient centered manifesto” would
change everything! One problem: the document was written by, for and from the
perspective of the Medical Nutrition Therapist, not the ADA doctor members. Did
they even read it?

So, what
will it take for more doctors to make “the turn”? If the Titanic is going to
“stay the course,” would there not be a business opportunity for enterprising
doctors and entrepreneurs to chart another course on a different “ship”? A
course that will NOT “trap patients in a lifelong regimen of drug management, obesity
and escalating diabetes.” Is there not a business opportunity for a
medical practice, led by a recognized leader and backed by solid science, to
multiply and expand using existing, established medical groups as well as
digital marketing?

Well, such a business
plan does exist, in a nascent stage. In
#293 I will tell you more about the HEAL Clinics.

Wednesday, February 25, 2015

While reading the MyFitnessPal article linked to here and in The
Nutrition Debate #290: “My Healthy, Homemade (Vinaigrette) Salad Dressing,”
I noted their choice of salad dressing oils included “olive oil, grape seed
oil, sesame oil, nut oils and avocado oil.” Also, two of the three recipes
featured used “olive oil” and the third, the Asian Vinaigrette, “vegetable
oil.” To their credit, they did not mention either soybean oil or canola oil,
the vegetable oils now most used (previously it was corn oil) in the processed
food industry’s bottled salad dressings. So, I decided to do a lipid analysis
of the oils they did include, using
the very useful USDA's National Nutrient
Database.
My research produced the following table:

Salad dressing oils (%)

PUFA

Mono

SFA

n-6

n-3

n6/n3

Olive oil

10.5

73.0

13.8

9.8

0.8

12.3

Avocado oil

13.5

70.6

11.6

12.5

1.0

12.5

Canola oil

28.1

63.3

7.4

18.6

9.1

2.0

Peanut oil ('nut oil')

32.0

46.2

16.9

32.0

0.0

∞

Sesame oil

41.7

39.7

14.2

41.3

0.3

137.7

Corn oil

54.7

27.6

12.9

53.2

1.2

45.8

Soybean oil

57.4

22.8

15.7

50.4

6.8

7.4

Walnut oil (nut oil)

63.3

22.8

9.1

52.9

10.4

5.1

Grapeseed oil

69.9

16.1

9.6

69.6

0.1

696.0

For my analysis I have arranged all the oils listed
in ascending order of their polyunsaturated fatty acids (PUFAs), The second
column is monounsaturated fat content and the third the saturated fatty acid
content. Then I list the Omega 6 percent, the Omega 3 percent and the ratio of
Omega 6 to Omega 3. Omega 6s and Omega 3s are PUFAs and are “essential fatty
acids.”

If you are reducing your consumption of Omega 6s,
and improving your Omega 6/Omega 3 ratio, or balance, you are no doubt aware
that you should avoid foods fried in vegetable or seed oils, and store-bought
baked goods made with these oils. For the
same reason you should avoid virtually all popular brand bottled salad
dressings. See table below for details.

To make your own salad dressing (see
#290), which oil then should you use? Well, olive oil (EVOO) is the clear
winner, equally for the reason that it is both highest (73%) in monounsaturated
fat (the “good” fat) and lowest (10.5%) in PUFAs (the “bad” fats). Avocado oil
and Macadamia nut oil, the latter not listed in the USDA Database, are both
very good but also very expensive. Canola oil isn’t bad, but is contains almost
3 times as many PUFAs (and about 10% fewer Mono’s) as olive oil. Besides, Canola Oil is made from a GMO
dominated crop (see additional citation about the GMO issue below).

Peanut oil and sesame oil are up to four times as
high in PUFAs as olive oil and have ugly n-6/n-3 ratios. (Peanuts are not nuts
actually, but legumes.) And corn oil and soybean oil have five times as many
PUFAs and only a third as much Mono as olive oil, so why would anyone (except a processed food manufacturer)
ever dream of using them?

Walnut oil is laden with over six times as much PUFA
as olive oil and less than one third as many monounsaturated fats as olive oil,
and then grapeseed oil is the
ugliest of them all: almost 70% PUFA with a n-6/n-3 ratio of almost 700.

Ken’s says they are “the number three manufacturer of salad dressings in the
United States behind Kraft Foods and Wish-Bone, including contract manufacturing for
companies such as Newman's Own.” What happened
to Hidden Valley, I wonder?

So, why doesn’t Kraft, et al., use olive oil in all
their industrially processed bottled salad dressings? Could it be that we don’t
grow olives commercially here in the U. S., and we grow lots of soybeans and
corn? Could it be that soy bean and canola oil are cheaper than olive oil?
Canola oil is produced from a low-acid cultivar of rapeseed, a member of the mustard family. As of 2005, 87% of the canola
grown in the US was genetically modified (GMO). That reminds me of a
favorite quote:

“People are fed by
the FOOD industry, which pays no attention to HEALTH and are treated by the
HEALTH industry, which pays no attention to FOOD.” The quote is from Wendell
Berry.

Saturday, February 21, 2015

MyFitnessPal recently
had a “cooking tip” titled, “How to Make Healthy, Homemade Salad Dressing (+ 3
Simple Recipes to Try).” I liked it for several reasons. 1) It was “relatable”
in that it addressed the majority of households who still purchase salad
dressing in bottles – doesn’t almost everyone? 2) It was well written and easy
to follow; and 3) I make a “killer” salad dressing myself (recipe later).
Naturally, therefore, I also found lots to disagree with and offer my own “improvements.”

The lede
brought a smile to my face: “As a kid, I would have been happy to drink Hidden
Valley ranch dressing out of a sippy cup, and I didn’t discover that salad
dressing could be homemade until a college summer abroad in Italy.”Can you relate?

I could
relate to both points. Packaged salad dressings are tasty. They’ve been
engineered in the processed food giants’ laboratories to be very palatable. And they are ready-made and convenient to use, so
the argument against using them has
to be strong. I won’t go into that here though. I’ll assume that if you have an
interest in making your own salad dressing you already know how BAD bottled salad
dressings are from multiple health points of view. (See also #291
coming next.)

And the
point about Italy is one that most diners know as well even without having
travelled to Italy. We’ll all eaten at the simple Italian Restaurant where
flasks of olive oil and vinegar are on the table for you to pour into a small
bowl filled with chopped iceberg, cherry tomatoes and shredded carrots. But for
my taste, as healthy as that dressing is, it’s not enough.

They
illustrate that with a jar filled with 60% oil, 30% acids and 10% other
flavors. Here’s where I pick my first bone. That ratio of oil to acid is just 2
to 1 (2:1). A traditional vinaigrette uses a 3:1 ratio, but I suspect My
Fitness Pal proposed to cut the oil portion to reduce the calories from fat
(oil). The problem is they then go on suggest that their basic vinaigrette
dressing be supplemented with “+ standard seasoning,” which they call your
“preferred sweetener.” Folks, a basic vinaigrette dressing does not use as a
standard seasoning your preferred sweetener, and to suggest jam/preserve is
absurd.

Then, they
state flatly the reasontheir
basic vinaigrette dressing requires a “sweetener.” They say, “This is used to balance out the tartness of
acids.” Readers, if you use a 2:1 ratio of oil to acid, your salad dressing
will be tart. If you use a 3:1, ratio
it will not. Adding sugar (jam/preserve) to your salad
dressing is not a good idea. It’s
much better to make less dressing and
then toss the salad thoroughly with the dressing to lightly coat the
ingredients. Nobody likes a salad drenched in dressing!

Another
aspect of the My Fitness Pal article that I liked was the range and variety of
the three basic “great vinaigrette” dressings they offered: Sweet, French and
Asian. However, as noted above, the first two recipes they offer use that 2:1
ratio of oil to acid. Their Sweet Vinaigrette uses balsamic vinegar (high in
carbs!) and adds 2 tsp. of jam to make ¼ cup, more than enough for a dinner
salad for 4. Their French Vinaigrette recipe uses red wine or sherry vinegar
and includes garlic (minced) and mustard, as does mine. Their Asian Vinaigrette
recipe uses a 3:1 ratio of oil to acid, adds soy sauce, and uses rice vinegar
and garlic. Sounds good!

My own
French Vinaigrette is made from Extra Virgin Olive Oil (EVOO) and tarragon
white wine vinegar (3Tbs:1Tbs), 2 or 3 cloves of minced garlic, a heaping
teaspoon of Grey Poupon mustard, ½ teaspoon of salt and 50 turns of freshly
ground black pepper. I put all the ingredients in a stainless steel bowl and
whisk thoroughly to emulsify them. Both the vinegar and the mustard are natural
emulsifiers, and the mustard
is also a surfactant, so it holds everything emulsified. I then let it
rest for 5 or 10 minutes to let the flavors fuse. Then just before serving, we
thoroughly toss the dressing with all the ingredients until everything is
evenly coated. This dressing recipe serves a large salad (4+ portions).

The salad we make is
made up of washed and dried, then torn romaine lettuce, cut endive, sliced
mushrooms, and usually some chopped hazelnuts, slivered almonds or toasted
walnuts, and cheese. If we’re having company, we may shave some aged pecorino
Romano on top, but usually we just add and toss in some grated or shredded
Parmesan. I always prefer my salad to be served separately on a side plate, but
not in a bowl. At home, we mix the salad in a large wooden bowl which we put it
on the table so everyone can serve themselves. Guests always comment on how
good it is, and go for seconds.

Wednesday, February 18, 2015

This
aphorism, commonly and apparently erroneously considered to be a part of the
Hippocratic Oath, is nevertheless attributed to Hippocrates (Epidemics, Bk. 1 Sect XI, according to PiedType). And “While there is
currently no legal obligation for medical students to swear an oath upon
graduating, 98% of American medical students swear some form of oath,” Wikipedia says, and a modified Hippocratic Oath was the most common,
according to a 1998 survey of Medical Schools.

“Physician, first do no harm,” is nevertheless,
“One of the fundamental principles of medicine according to which the physician
should not cause harm to the patient” (Mosby's
Medical Dictionary). Regardless of the oath taken (or not taken), it is
the moral obligation of the physician to do “the right thing” by his or her
patient. Who could disagree with that?

It is therefore all the more interesting
that in the original oath (as translated in the Wiki citation above),
Hippocrates pledges, “With regard to healing the sick, I will devise and
order for them the best diet, according to my judgment and means; and I will
take care that they suffer no hurt or damage.”And it was,
after all, Hippocrates, the
father of Western medicine, who said, “Let food be thy medicine and medicine be
thy food.” I first cited this in “The
Nutrition Debate #173.”

In #173 I
compared what were then two translations in the Wikipedia entry for the
Hippocratic Oath. The first had the sentence, “I will apply dietetic measures for the benefit of
the sick according to my ability and judgment.” The current translation in the
earlier Wiki revised it to, “I will prescribe
regimens for the good of my patients according to my ability and my
judgment and never do harm to anyone.” Notice the difference? “Apply dietetic
measures” was replaced by “prescribe.”

I
understand, of course, that pharmacotherapy did not exist in ancient Greece,
although herbal medicines, salves, etc. have existed since the beginning of
time. But so has the enduring and timeless truth: “Let food be thy medicine and
medicine be thy food.” And can any doctor not
acknowledge that the best medicine for treating type 2 diabetes is “the best
diet?” Then, assuming that every doctor would agree with this prescription, the
question arises, why would any doctor not prescribe for every
patient a diet much lower in carbs than the 60% carbs that is the
USDA’s Nutrition Facts Panel standard? (See #288).

If the
physician is truly and sincerely acting in the beneficent spirit of the
Hippocratic Oath, why would he or she not literally “…apply dietetic measures
for the benefit of the sick according to my ability and judgment?” The answer to this question is, of course,
complicated: There’s the question of 1) laziness, 2) a lack of time, 3) patient
“non-compliance,” 4) a dietary plan (restricted calorie, “balanced,” low-fat)
that is doomed to fail, 5) guidelines that a doctor must comply with to be paid
for services paid for by 3rd party payers (government agencies like
HHS/Medicare and Medicaid and private insurance that must conform with
government guidelines and 6) low reimbursement rates by those 3rd
party payers for patient services.

As a
consequence, writing a script and updating the patient’s electronic medical
record are all that most physicians have time to do. Medicine as practiced
today in many large offices is at best just a business; at worst, it’s a sham.
I’m lucky. I have a caring physician (I hope he reads this) who is glad to see
me and give me the time I need. Now if I can just get nurse to treat me the
same way. She has been with him so long that to her I am just another product
on the office assembly line. Remember Lucille & Ethel
wrapping chocolates on a factory conveyor belt? It was one of the
funniest pieces they ever did.

You may
have noticed that I failed to mention one more possibility for why a physician
would not regard a low-carb diet as the “best medicine” for virtually everyone,
but especially for people with Metabolic Syndrome, borderline lipids, chronic
systemic inflammation, or who are overweight, obese, pre-diabetic or diagnosed
with type 2 diabetes. I didn’t include the possibility that the physician may actually believe that a restricted
calorie, balanced, low-fat diet is the best way to lose weight and keep it off
and see improvement in all these conditions, plus hypertension (high blood
pressure) and reduced risk of coronary heart disease, cardiovascular disease,
several types of cancer and even Alzheimer’s disease.

The reason
I didn’t mention it is that I can’t believe that there are any doctors left who
still believe that. The evidence has been piling up from so many sources, and
is now aggregated in huge meta analyses - they cannot not have seen it. Just in
case, though, this very comprehensive 12-points-of-evidence
elucidation in the January 2015 issue of Nutrition,
by Richard Feinman et al., covers just about all the bases. So this can’t
be the reason anymore. There must be more to it. Could it be that it’s very
hard to switch horses in mid-stream (mid-career)? Will we have to wait until
the current generation of doctors all die? Will that be too late for you? The doctor who started me on low-carb
(Atkins Induction) was semi-retired. Maybe he figured he had not much to lose.
He took a chance and put his patient’s health first. Maybe you, the patient,
should too.

Saturday, February 14, 2015

This
Medscape Multispecialty piece headline (Anne Harding from
Reuters Health Information) was actually, “10% Protein Diet May Not Maintain
Muscles in Type 2 Diabetes.” The lede was, “New findings suggest it’s
especially important for people with type 2 diabetes to eat enough protein.”
This is a message with which I am in complete agreement. Regular readers will
recall that I have written about it numerous times including in #130, “How
Much Protein Should You Eat?”

What
reconnected me to the subject this time was the specific mention of 10% (as not
being enough protein). Ten percent
protein is the exact amount
of protein that the Nutrition Facts Panel on every packaged food product in the
United States recommends that everyone
eat. Our government’s one-size-fits-all dietary recommendations do not take
into account the requirements of different cohorts of the population, excepting
those under 2 years of age. In that case, you are allowed to eat more saturated
fat (as is found in mother's
milk) to help in brain development. After 2 years, I guess your
brain stops developing – NOT. (Current research suggests age 25.) And Type 2 diabetics should eat more fat,
more protein, and many fewer carbohydrates than is recommended to the
general population. EVERYONE, actually, should eat many fewer.

(Anyway, if
you haven’t done the math, the RDA percentages on the side panel of packaged
foods are based, as the USDA’s footnote says, on a 2,000 calorie a day diet
(for a “woman of a certain age”) to maintain her weight. So, if a “serving” has
say 30 carbs, that’s 10% of the RDA for
carbs. Here’s how to figure it: 30 grams of carbs x 4 calories/gram of carbs =
120 calories, and 120 calories is 10% of 1,200. From this you can correctly conclude that the 2,000 calorie a day diet
that the government recommends everyone eats is 60% carbohydrate. I’m not making this up folks!

Do the math
yourself for proteins. If the panel lists the serving as 20 grams of protein,
it will say that serving represents 40% of your RDA. Since protein has 4
calories per gram, 20 x 4 = 80 calories which is 40% of 200. And since 200 is
only 10% of 2,000 (the total daily calorie allowance), 10% is the amount of protein that the government recommends you eat.
Q.E.D.

By reverse
math, the balance of your diet is supposed to be fats: 1,200 + 200 = 1,400;
2,000 - 1,400 = 600 calories for fat, and since fat has 9 calories per gram,
600/9 = 66.7 grams of fat. And 600/2000 = 30% fat in a 2,000 calorie diet.)

But I
digress. The article cited above was written by Dr. Stephanie Chevalier, et
al., of McGill University Health Center – Royal Victoria Hospital in Montreal
and was published in Clinical Nutrition.
“If it [a 10% protein diet] happens over a long period of time, this could lead
to loss of muscle mass. That’s really an issue for our aging population,” Dr.
Chevalier said.

The study,
in organic biochemistry terms, “involved comparing two groups of obese men and
women, all type 2 diabetics, eating isocaloric diets, one of 17% protein and
the other 10%. “On a 10% protein diet, diabetic adults showed increased
sensitivity to insulin suppression of proteolysis, but inadequate stimulation
of protein synthesis, resulting in a low net nitrogen balance than similar
patients who ate a 17% protein diet.” Okay, this is above my pay grade too.

The reason,
put simply, is that “Insulin is required for the metabolism of all
macronutrients, not just glucose, and people with type 2 diabetes have been
shown to have insulin resistance to glucose, lipid [fat], and protein
metabolism,” Dr. Chevalier told Harding. She added, “Studies have shown that
older adults with diabetes have greater losses in muscle mass and strength over
time.” The takeway for me is that Insulin Resistance applies to fat and protein
metabolism too!

She
concluded, “For now, it’s probably
adequate for people with diabetes to eat diets containing 15% to 20% protein. Ten
percent is definitely too low,” she said, definitively. That was comforting
to me. My own diet, as my regular readers know, is 20% protein, 5% carbohydrate
and 75% fat. My protein plan has been higher in the past (as high as 28%), and
usually in fact is higher than 20% since I frequently eat more than the small
portion of protein allocated for supper (25g). That’s also why I take a small
dose of metformin at supper, to suppress any gluconeogenesis that may result
from a larger portion. If you haven’t seen my “ideal” meal plan, this is what
it looks like. The breakfast and lunch parts of the plan are always the
easiest.

Wednesday, February 11, 2015

The
Nutrition Debate #88: “Reversal
of Type 2 Diabetes,” has proved, to my surprise, to be a very popular post on this blog; it has had over 6,000 page views. Let me be clear: I do not
believe that type 2 diabetes can be “reversed,” and so I can understand that
someone reading that post (#88) might have felt misled by me. That was not my intention.
Nor was I consciously intending to glom readers by attracting them to an
appealing prospect through a headline. I was simple reporting on a paper in a
peer-reviewed British medical journal that had precisely that title; that’s why my blog title was in quotes.

The paper
was interesting. Its “AIMS/HYPOTHESIS” is that
“Type 2 diabetes is regarded as inevitably progressive, with irreversible beta
cell failure. The hypothesis was tested that both beta cell failure and insulin
resistance can be reversed by dietary restriction of energy intake.” Okay, it’s
a hypothesis. Its aim is to challenge an assumed truth – one that virtually all
medical practitioners espouse – that type 2 diabetes is “inevitably
progressive.” And they propose to do it by “dietary restriction of energy
intake” alone. To be clear, they mean fewer calories,
not fewer carbohydrates. Interesting,
huh?

The hypothesis apparently sprang from the
observation that “normal glucose metabolism is restored within days after bariatric
surgery in the majority of people with type 2 diabetes.” “There is now no doubt,” they concluded and
report in their Counterpoint Study, “that this reversal of diabetes depends
upon the sudden and profound decrease in food intake, and does not relate to
any direct surgical effect.” To be clear: That’s food (total energy) intake,
not carbohydrates.

The CONCLUSION/INTERPRETATION of this
study was only a little less assertive than their hypothesis: “Normalization of
both beta cell function and hepatic insulin sensitivity in type 2 diabetes was
achieved by dietary energy restriction alone. This was associated with
decreased pancreatic and liver triacylglycerol stores. The abnormalities
underlying type 2 diabetes are reversible by reducing dietary energy intake.”
Okay, they hedge a bit. They say “the abnormalities underlying type 2 diabetes
are reversible…” But they still use the word “reversible.” That’s pretty
strong, but they are scientists and provide the quantitative data to support
their findings: pancreatic and liver fat cells (triglycerides).

My inveterate editor discovered a
follow-up study that was done by the same researchers, and I reported on in The
Nutrition Debate #89, “‘Reversal of Type 2 Diabetes' Revisited.” Unfortunately, it glommed only 367 page views, but in it
the authors reported on “individuals (who) began to feed back their personal
experiences of attempting to reverse their diabetes.” CONCLUSION: “These data demonstrate that
intentional weight loss achieved at home by health-motivated individuals can
reverse Type 2 diabetes. Diabetes reversal should be a goal in the management
of Type 2 diabetes.”

This and other work by these intrepid researchers
earned them the high privilege of presenting “The 2012 Banting Memorial Lecture: Reversing the twin cycles of Type 2
diabetes” (full text link here).
So, they are clearly not crackpots. They are scientists looking for answers to
why and how the “underlying abnormalities” of type 2 diabetes are “reversed.”
From my perspective, they have demonstrated to their medical peers that their
work was at the very least “interesting.”

The paper based on the Banting Lecture that was
published in Diabetes, the organ of
the American Diabetes Association. The abstract concludes: “It is now clear that Type 2 diabetes is a
reversible condition of intra-organ fat excess to which some people are more
susceptible than others.” But they’re talking about “pancreatic and liver
triglycerides.”My readers are not
particularly interested in their pancreatic and liver triglycerides. They don’t
even care that much about their serum triglycerides (although The Nutrition
Debate #197: “Triglycerides and Alcohol Consumption,” logs over 1,500 hits). People with Type 2
Diabetes want to know how to “eradicate” the damn disease. Ideally with just a
pill!!!

My readers are also interested in what they can do,
if anything, to avoid being “more susceptible.” And if they were “more susceptible,”
if there is anything they can then do to “reverse” the “condition” to which
they have succumbed. My conclusion is that if you are among those who are
susceptible, and have succumbed to the condition in the sense that you are
diagnosed diabetic or pre-diabetic, and you are sincere about mitigating the
risk of diabetic complications (both micro and macro vascular), there is a
course of action you can take, and it is stated in the CONCLUSION of the
overlooked post #89, to wit:

“These data demonstrate that intentional weight loss
achieved at home by health-motivated individuals can reverse Type 2 diabetes.
Diabetes reversal should be a goal in the management of Type 2 diabetes.” And
in my book the best way to lose weight is to eat Low Carb, not cans of
Optifast, the 47% carb liquid diet formula used in this study.

Saturday, February 7, 2015

Kurt G.
Harris, MD, called wheat, excess fructose and excess linoleic acid the
Neolithic Agents of Disease (NAD). He was one of my early favorites in my
search for a dietary regimen that could be stated as a philosophy of eating
rather than by a dependency on counting calories, carbs and other
micronutrients. I wrote about him and his PaNu program four years ago in The
Nutrition Debate #19 here. Then he
dropped out of “the nutrition debate” and later deleted his Archevore website.
Today he is a diagnostic radiologist practicing in Sturgeon Bay, WI. Some of his writing is still
online at Psychology Today.

Harris
didn’t write for type 2 diabetics like me. He aimed his program at people who
wanted to eat in a healthy way to avoid disease. Many others followed him in
this goal and the field became a tangled mess, leading sadly I suspect to his
premature retreat. For awhile I hoped he was writing a book. Alas, it seems
not. Harris was inspired, he wrote, by Gary Taubes (as was I). His epiphany,
and his openness and training in scientific method, fed his inquiring mind. He
liked to write and coin words and phrases too. If this sounds like a eulogy
it’s only because I fear he is lost to us, and it is our loss.

The three
NADs, which he fully explains in “A
Dietary Manifesto - Paleo 2.0,” are just another way of
describing his 12-step program (which I list in The
Nutrition Debate #19), for “getting started,” and going “as far as you can
down the list…” The wheat proscription means gluten, and of course includes the
other gluten grains (barley, rye, etc). That’s big.

The excess fructose NAD is also a big one,
but here Harris leaves a little room if you’re not diabetic or prediabetic.
Harris is infamous (in Paleo circles) for calling apples “bags of sugar” and
most modern fruit “candy bars on a tree.” He concludes, however, “If you are not
trying to lose fat [or are carb intolerant as in type 2 diabetes], a few pieces
of fruit a day are fine.” Fructose, however, is not only found in fruit, as horfilmania (“Who Knew?” 12/21/14) recently
discovered with red cabbage. Take a look at “The Nutrition Debate #97” for a list of common sweeteners, fruits
and vegetables that contain fructose.

Avoiding excess linoleic acid (Omega 6s) is
perhaps the hardest dietary goal of the three NADs because it is so hard to
know where they hide. Harris advises, “The way to correct the modern excess of
n-6 linoleic acid is to avoid the modern sources of it. Stop eating all
temperate vegetable oils and veggie oil fried food- cooking and frying oils like
corn, soy, canola, and flax, all of it. And go easy on the nuts and factory
chicken. These are big sources of n-6, especially the nuts and nut oils.”

To put some
“meat” on those recommendations, I’ve created this table using the USDA’s
National Nutrient Database:

Cooking/salad oils & fats (%)

SFA

Mono

PUFA

n-6

n-3

n6/n3

Corn oil

12.9

27.6

54.7

53.2

1.2

45.8

Soybean oil

15.7

22.8

57.4

50.4

6.8

7.4

Canola oil

7.4

63.3

28.1

18.6

9.1

2.0

Olive oil

13.8

73.0

10.5

9.8

0.8

12.8

Butter (incl.+/-16% water)

51.4

21.0

3.0

2.2

0.3

6.9

Coconut oil

85.5

5.8

1.8

1.8

0

∞

All fats are combinations of saturated fatty acids
(SFAs), monounsaturated fatty acids (Mono) and polyunsaturated fatty acids
(PUFAs), but the composition varies enormously. Corn and soybean oil are over
50% PUFA, while butter and coconut oil are 3% and 1.8% respectively. On
average, corn oil and soybean oil have over 25 times as many PUFAs as the
saturated fats. Canola oil has 10 times as much; olive oil, 5 times as much.
Note: The “saturated fats” still have PUFA content.

As most
people know the ratio of n-6 to n-3 is also important, and Canola oil has the
best and corn oil the worst ratio. But in terms of absolute numbers, the best
advice is to avoid excess Omega 6s (n-6s) altogether, and that is best done by
eliminating all seed and vegetable oils. Then, as Harris says in his Manifesto,
“Along with n-3, the other type of PUFA, it [n-6] is technically an essential
fatty acid, but the actual requirement is
so small it might be better considered a micronutrient”(emphasis mine).

So, avoid all
vegetable and seed oils altogether (corn, soybean, Canola, sunflower, walnut,
flax, etc.), and then avoid all prepared, baked goods and foods fried in any of
these oils, then go easy on nuts, nut oils and factory chicken, and maybe
supplement with Omega 3 fish oils to help the balance, and you should get your
ratio back into pre-Neolithic proportions. If this sounds like Paleo to you, it
isn’t really. It’s just a little nostalgic look back at the “ancestral” roots
of my dietary journey.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.